Nokea
A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take?
- A. Obtain an order for BUN and creatinine levels
- B. Reassure the patient that this is a harmless effect
- C. Request an order for a urinalysis
- D. Test her urine for occult blood
Correct Answer: B
Rationale: Reddish-brown urine is a benign metronidazole side effect; no labs are needed. Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern.
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A 66-year-old man is admitted to the hospital with confusion, nausea, and blurred vision. He is currently on digoxin for the treatment of heart failure. On physical exam, his heart rate is 120 bpm. Further evaluation reveals a digoxin level of 5.3 ng/mL (normal range: 0.5-2 ng/mL). The doctor believes his symptoms are due to digoxin toxicity. Which parameter is used to indicate the ability of digoxin to produce the desired effect relative to a toxic effect?
- A. Bioavailability
- B. Efficacy
- C. Intrinsic activity
- D. Therapeutic index
Correct Answer: D
Rationale: Therapeutic index (TI) measures the relative safety of a drug by comparing the dose required for a therapeutic effect to the dose that produces toxicity. In this case, digoxin toxicity is indicated by the elevated level, and TI is the relevant parameter.
Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor?
- A. Elevated serum transaminase
- B. Increased serum creatinine
- C. Elevated creatinine kinase
- D. Increased white blood cell counts
Correct Answer: D
Rationale: WBC elevation is unrelated to reductase inhibitors; others indicate liver, kidney, or muscle issues.
When reviewing the phases of drug development, the nurse finds a discussion about the postmarketing surveillance phase. Which one of the following activities would the nurse expect to find as being carried out during this phase?
- A. Health care providers report adverse effects to FDA.
- B. Healthy volunteers are involved in the test.
- C. In vitro tests are performed using human cells.
- D. The drug is given to patients with the disease.
Correct Answer: A
Rationale: The postmarketing surveillance phase of drug development encourages health care professionals to report adverse effects of drugs to the FDA using MedWatch. Phase 1 of clinical testing involves 20 to 100 healthy volunteers. In vitro testing of the drug on human or animal cells is done in the pre-FDA phase. In Phase 2 of clinical testing, the drug is given to patients with the disease for which the drug is manufactured.
An overdose of amitriptyline may precipitate all the following adverse effects EXCEPT:
- A. Cardiac arrhythmias
- B. Hypotension
- C. Sedation
- D. Jaundice
Correct Answer: D
Rationale: Amitriptyline overdose does not typically cause jaundice; it causes anticholinergic and cardiac effects.
When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:
- A. The medication may cause sedation and they should not drive.
- B. Constipation is a common side effect and they should increase fluids and fiber.
- C. Patients should not take any other acetaminophen-containing medications at the same time.
- D. All of the above
Correct Answer: D
Rationale: All are critical: sedation, constipation, and acetaminophen overdose risks.